ENROLMENT FORM

ENROLMENT FORM

Please complete your application. This registration form is a legal document. Before the student can be registered by Global Jaya School, this form must be competed by the parent to ensure we can proceed to the next stage.
STUDENT'S INFORMATION
Register for the school year*
Prospective Student's Name*

First NameLast Name
Place of Birth*
Birth Date*

MonthDayYear
Gender*
Address*

Street Address

Street Address Line 2

CityProvince

Postal CodeCountry
Class Registration*
Phone Number*

Area CodePhone Number
Student Religion*
Student living with*
Previous School*
Promo Code
1st Language*
2nd Language*
Nationality*
2nd Nationality

PARENT'S INFORMATION
FATHER
Father's name*

First NameLast Name
Relation to Child*
Deceased
Address*

Street Address

Street Address Line 2

CityProvince

Postal CodeCountry
Mobile Number*

Area CodePhone Number
Email*
example@example.com
Religion*
Highest Educational Background*
Occupation*
Company Name*
MOTHER
Mother's name*

First NameLast Name
Relation to Child*
Deceased
Address*

Street Address

Street Address Line 2

CityProvince

Postal CodeCountry
Mobile Number*

Area CodePhone Number
Email*
example@example.com
Religion*
Highest Educational Background*
Occupation*
Company Name

SIBLING'S INFORMATION
Sibling's Information 1

First NameLast Name
Birth Date

MonthDayYear
Gender
School's name
Class
Sibling's Information 2

First NameLast Name
Birth Date

MonthDayYear
Gender
School's name
Class
Sibling's Information 3

First NameLast Name
Birth Date

MonthDayYear
Gender
School's name
Class

MEDICAL RECORD

Please inform us of your child's medical information. It will support their learning process at our school. The Medical Record form should be completed, signed, and submitted after careful perusal.
Height*
Weight*
Blood Type*
Blood Rhesus*
Wears Glasses/Contact Lens*
Uses Hearing Aid*
Dominant hand for daily activities*
Does your child have a history of ADHD, seizure disorder, heart condition, eczema, diabetes, asthma, migraines or any other medical concerns? (If the answer is Yes, please explain)*
Does your child have any congenital (birth) disorders, suffered a serious injury, or had any major surgeries? (If the answer is Yes, please explain)*
Does your child have any allergies or drug sensitivities (If the answer is Yes, please explain)*
Does your child take any medication? (If the answer is Yes, please explain)*
Does your child have any physical, mental or emotional limitations we should be aware of? (If the answer is Yes, please explain)*
Please attach your child's immunization record.

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With this state, as the parent/legal guardian, I agree to:*

Accept the Principal's decision in evaluating the student's assessment and behavior within the school and that Global Jaya School has the right to refuse admission or expel the student.We authorize the school to give first aid in case of an emergency and seek further medical attention if required. The school will contact parents as soon as possible. I acknowledge that it is my responsibility to inform GJS of any update regarding child's medical record.We understand that the school may use photographic or video images of our child for promotional purposes. The school will ensure that any such material will not show any children in negative or uncomplimentary nature.

Dear Parents,

Thank you for filling out our online form. You may proceed with the enrolment fee payment of Rp.800,000/child to Global Jaya School Bank Account:
CIMB Niaga Cabang Pondok Indah
Yayasan Pendidikan Jaya
#8000.31978.500
Swift Code BN IAIDJA

Please provide us with the required documents in pdf format as follows:
1. Candidate's Birth Certificate
2. Family Card/Kartu Keluarga (for Indonesian candidate) or KITAS (for the expatriate candidate) stating the candidate's name
3. Report Cards from the last three years

Enrolment will not be processed until all information is supplied.

Please send the bank receipt & documents to our Admission Officer at admissions@globaljaya.com. Our admission officer will contact you soon and assist you with the admission process.

Thank you, and we're looking forward to hearing from you soon.
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ENROLMENT FORM

STUDENT'S INFORMATION

PARENT'S INFORMATION

FATHER

MOTHER

SIBLING'S INFORMATION

MEDICAL RECORD